A Systematic Approach to Viewing and Treating Apraxia of Speech: Part Four – The Sustained Phonatory Modeling Technique
Part Four: The Sustained Phonatory Modeling Technique
So based on the theory I have presented (The Movement Pattern Generalization Theory) we may only need to focus therapy on a movement pattern basis (2 pure speech sounds with the movement in-between). This theory is great – but I am sure all of the therapists out there (as well as parents) are wondering how this theory translates into the actual therapy process. Well, that is where the Sustained Phonatory Modeling Technique comes in to play.
If we know that the issue with Apraxia of speech is a movement issue – then we need to be targeting the movement in therapy – right? But how??? Well, over the last five years or so I have been perfecting the way I deliver therapy to my clients with Apraxia. I have studied and used techniques such as the Kaufman Praxis program and the PROMPT therapy program. Both of these programs/techniques are exceptional and helped me gain a feel for treating children with Apraxia. However, I always felt that the beginning stages of therapy were difficult as I tried to narrow down which targets I was going to focus on first – which techniques would be the most effective – and so forth. Through trial and error I have been able to use the things I have been trained to use in conjunction with my own problem solving skills to create a systematic treatment approach for children with Apraxia.
This model consists of you (the therapist or parent) producing a pure consonant or vowel and sustaining it. While sustaining your sound – use visual and tactile modeling to help the child imitate the sound. As soon as the child has begun imitating the first sustained sound – you (the therapist or parent) move on to the next sound and sustain it. While sustaining the second sound – use visual and tactile modeling to help the child imitate the second sound. Do not move on to the second sound until the child has produced the first sound and sustained it. Move slowly from the first sound to the second sound so that the child can gain as much information as possible about the movement (auditory and visual information). But begin practicing the movement faster and faster each time in order to teach the child the natural (vs. exaggerated) way to say the target. As the child begins following your movement pattern from the first sound into the second sound – help enforce the correct movement with tactile/touch support. Provide as much support as possible in the beginning stages to help the child learn the movement pattern with as little error as possible. Fade the support as soon as possible to help allow the child to become independent at the movement pattern. This technique is great because it allows the child to hear the target, see the target, and feel the target in a systematic fashion.
The most important factor in this technique is the sustained phonation of sounds. This is because Apraxia is a MOVEMENT disorder. If you present a sound (without sustaining it) and then try to help the child imitate the sound, and then move on to the next sound – you actually end up working on the sounds almost in isolation (all by themselves) and you miss the movement between the sounds. The movement between the sounds is the most important part of therapy when working with individuals with Apraxia. Remember in my previous posts how I mentioned the difference between artic/phonological kiddos and kiddos with Apraxia?? For “typical” speech kids (artic/phonological) we teach them how to produce Point A (/b/) and Point B (/eI/) – and they fill in the dots between the two to make a word (/beI/ or “bay”). But for kids with apraxia we have to teach not only Point A and Point B – but we also (and most importantly) have to teach them how to produce the dots in between the two points. We are literally teaching the MOVEMENT. It is almost impossible to teach the movement in between the two sounds without sustaining your phonation during your model.
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What do you do with sounds that aren’t continuents? /t, d, k, g/
I tried to make the jump to sounds that aren’t continuents and he is having trouble generalizing the movement patterns in CV syllables for those sounds. Should I go back to practicing with the continuent sounds and then try the stop sounds again later? What has been your experience? Thanks for any feedback.
I would actually consider moving to a new syllable shape. I am assuming you are working on CV syllable shape because that is usually the easiest. However, I have found that non-continuent sounds (i.e. stops and sometimes affricates) are usually easier to teach in VC syllable shapes – especially if you are using the sustained phonatory technique. It is much easier to connect /aaaap/ than /ppppa/. Is this making sense?? I would start with vowels and consonants that the child is familiar/successful with in a VC syllable shape. Then move into non-continuent sounds in the VC shape. And once the child has those sounds in VC – try moving them back into CV. Hope that works. Great questions and let me know if you have any more 🙂
I actually started just by talking to my own children’s pediatrician during his well-check visits. Fortunately for me, my children’s pediatrician was totally on board – in fact – he was super excited that he would have a local referral source. I started small, receiving referrals from his office. Luckily, the office he works in houses 3 other pediatricians and together they all cover a huge percentage of the children in my area. After I started getting referrals from their office, I sent out a simple letter, just explaining who I was and giving more information about my practice to other pediatrician offices in the area. I have since visited quite a few offices in person and scheduled times that I could meet with doctors/dentists/orthodontists to explain even more. However, some of my best marketing and referral sources have simply come from my website (people finding me on their own), other therapists in the area, old clients, and coupons that I handed out when I participated in the local parade. Good luck!!!